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Study tests tubes used in kids with excess ear fluid

San Jose Mecury News
By Susan FitzGerald
Knight Ridder

Hundreds of thousands of children each year in the United States get tiny tubes surgically inserted into their eardrums as a remedy for repeated, severe ear infections or a chronic buildup of fluid in the middle ear.

The tubes have been shown to reduce the number of infections in children who have recurring ear problems. Tubes also are thought to be a good idea for children with persistent fluid buildup because the condition can muffle hearing, which could interfere with speech and language development.

But new studies are raising questions about whether ear tubes for children with fluid buildup makes a difference in long-term development.

Dr. Jack Paradise, a researcher at Children's Hospital of Pittsburgh, has been tracking several hundred children who were diagnosed with persistent fluid in the middle ear. He compared children who had ear tubes put in fairly quickly to those who got the tubes after a longer waiting period, or in some cases not at all.

In a report published in August in the journal Pediatrics, his team said no significant differences were found at age 4 between the two groups in language, speech and other development measures -- a finding that raises questions about the use of tubes simply because of worries about development.

Whether such findings will translate into fewer ear-tube surgeries isn't clear.

Doctors use varying criteria for deciding whether to recommend ear tubes for a child. The tubes must be inserted with the child under general anesthesia, at a cost of a couple of thousand dollars. Children are often referred for ear tubes if fluid in the middle ear does not clear up after three months and there are signs of hearing loss.

The American Academy of Pediatrics is working with two other professional groups on new guidelines on the use of ear tubes for fluid buildup, which should help clarify their use.

Allan Lieberthal, a pediatrician with Kaiser Permanente in California who serves on the committee, said one of the recommendations is likely to be for ``more observation before tubes are considered.''

The tubes, called typanostomy tubes, are inserted into the ear drum, allowing air to get into the middle ear. That helps relieve pressure and allows for better drainage of pus and fluid through the ear canal.

William Potsic, director of pediatric ear, nose and throat surgery at Children's Hospital of Philadelphia, said he sees plenty of valid reasons for putting ear tubes in children with chronic fluid buildup and hearing loss.

``If you ask parents, `Is it OK for your child to have a hearing loss for six out of nine months of the school year while they are supposed to be embracing the educational environment?' most parents won't tolerate that,'' he said.

Copyright 2003 Knight Ridder.



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